Provider Demographics
NPI:1396903753
Name:COHN, ANITA DIANE
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:DIANE
Last Name:COHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BON PRICE LN
Mailing Address - Street 2:
Mailing Address - City:OLIVETTE
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3728
Mailing Address - Country:US
Mailing Address - Phone:314-920-0803
Mailing Address - Fax:
Practice Address - Street 1:11 BON PRICE LN
Practice Address - Street 2:
Practice Address - City:OLIVETTE
Practice Address - State:MO
Practice Address - Zip Code:63132-3728
Practice Address - Country:US
Practice Address - Phone:314-920-0803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-01
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080138141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical